Paula Muñoz Venturelli1,2,3, Jason P Appleton4,5, Craig S Anderson6,7,8, Philip M Bath4,5. 1. Clinical Research Center, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile. 2. Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Santiago, Chile. 3. The George Institute for Global Health, University of New South Wales, Sydney, Australia. 4. Stroke Trials Unit, Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK. 5. Stroke, Nottingham University Hospitals NHS Trust, Nottingham, UK. 6. Clinical Research Center, Instituto de Ciencias e Innovación en Medicina, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile. canderson@georgeinstitute.org.au. 7. The George Institute for Global Health, University of New South Wales, Sydney, Australia. canderson@georgeinstitute.org.au. 8. The George Institute China at Peking University Health Science Center, Beijing, China. canderson@georgeinstitute.org.au.
Abstract
PURPOSE OF REVIEW: The management of patients with acute stroke has been revolutionized in recent years with the advent of new effective treatments. In this rapidly evolving field, we provide an update on the management of acute stroke excluding thrombectomy, looking to recent, ongoing, and future trials. RECENT FINDINGS: Large definitive trials have provided insight into acute stroke care including broadening the therapeutic window for thrombolysis, alternatives to standard dose alteplase, the use of dual antiplatelet therapy early after minor ischemic stroke, and treating elevated blood pressure in intracerebral hemorrhage. Further ongoing and future trials are eagerly awaited in this ever-expanding area. Although definitive trials have led to improvements in acute stroke care, there remains a need for further research to improve our understanding of pathophysiological mechanisms underlying different stroke types with the potential for treatments to be tailored to the individual.
PURPOSE OF REVIEW: The management of patients with acute stroke has been revolutionized in recent years with the advent of new effective treatments. In this rapidly evolving field, we provide an update on the management of acute stroke excluding thrombectomy, looking to recent, ongoing, and future trials. RECENT FINDINGS: Large definitive trials have provided insight into acute stroke care including broadening the therapeutic window for thrombolysis, alternatives to standard dose alteplase, the use of dual antiplatelet therapy early after minor ischemic stroke, and treating elevated blood pressure in intracerebral hemorrhage. Further ongoing and future trials are eagerly awaited in this ever-expanding area. Although definitive trials have led to improvements in acute stroke care, there remains a need for further research to improve our understanding of pathophysiological mechanisms underlying different stroke types with the potential for treatments to be tailored to the individual.
Authors: Craig S Anderson; Hisatomi Arima; Pablo Lavados; Laurent Billot; Maree L Hackett; Verónica V Olavarría; Paula Muñoz Venturelli; Alejandro Brunser; Bin Peng; Liying Cui; Lily Song; Kris Rogers; Sandy Middleton; Joyce Y Lim; Denise Forshaw; C Elizabeth Lightbody; Mark Woodward; Octavio Pontes-Neto; H Asita De Silva; Ruey-Tay Lin; Tsong-Hai Lee; Jeyaraj D Pandian; Gillian E Mead; Thompson Robinson; Caroline Watkins Journal: N Engl J Med Date: 2017-06-22 Impact factor: 91.245
Authors: Yining Huang; Vijay K Sharma; Thompson Robinson; Richard I Lindley; Xiaoying Chen; Jong Sung Kim; Pablo Lavados; Verónica Olavarría; Hisatomi Arima; Sully Fuentes; Huy Thang Nguyen; Tsong-Hai Lee; Mark W Parsons; Christopher Levi; Andrew M Demchuk; Philip M W Bath; Joseph P Broderick; Geoffrey A Donnan; Sheila Martins; Octavio M Pontes-Neto; Federico Silva; Jeyaraj Pandian; Stefano Ricci; Christian Stapf; Mark Woodward; Jiguang Wang; John Chalmers; Craig S Anderson Journal: Int J Stroke Date: 2015-04-02 Impact factor: 5.266
Authors: S Claiborne Johnston; Pierre Amarenco; Gregory W Albers; Hans Denison; J Donald Easton; Scott R Evans; Peter Held; Jenny Jonasson; Kazuo Minematsu; Carlos A Molina; Yongjun Wang; K S Lawrence Wong Journal: N Engl J Med Date: 2016-05-10 Impact factor: 91.245
Authors: Paul K Whelton; Robert M Carey; Wilbert S Aronow; Donald E Casey; Karen J Collins; Cheryl Dennison Himmelfarb; Sondra M DePalma; Samuel Gidding; Kenneth A Jamerson; Daniel W Jones; Eric J MacLaughlin; Paul Muntner; Bruce Ovbiagele; Sidney C Smith; Crystal C Spencer; Randall S Stafford; Sandra J Taler; Randal J Thomas; Kim A Williams; Jeff D Williamson; Jackson T Wright Journal: Hypertension Date: 2017-11-13 Impact factor: 10.190
Authors: Werner Hacke; Greg Albers; Yasir Al-Rawi; Julien Bogousslavsky; Antonio Davalos; Michael Eliasziw; Michael Fischer; Anthony Furlan; Markku Kaste; Kennedy R Lees; Mariola Soehngen; Steven Warach Journal: Stroke Date: 2004-11-29 Impact factor: 7.914
Authors: Bruce C V Campbell; Peter J Mitchell; Leonid Churilov; Nawaf Yassi; Timothy J Kleinig; Richard J Dowling; Bernard Yan; Steven J Bush; Helen M Dewey; Vincent Thijs; Rebecca Scroop; Marion Simpson; Mark Brooks; Hamed Asadi; Teddy Y Wu; Darshan G Shah; Tissa Wijeratne; Timothy Ang; Ferdinand Miteff; Christopher R Levi; Edrich Rodrigues; Henry Zhao; Patrick Salvaris; Carlos Garcia-Esperon; Peter Bailey; Henry Rice; Laetitia de Villiers; Helen Brown; Kendal Redmond; David Leggett; John N Fink; Wayne Collecutt; Andrew A Wong; Claire Muller; Alan Coulthard; Ken Mitchell; John Clouston; Kate Mahady; Deborah Field; Henry Ma; Thanh G Phan; Winston Chong; Ronil V Chandra; Lee-Anne Slater; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Christopher F Bladin; Gagan Sharma; Patricia M Desmond; Mark W Parsons; Geoffrey A Donnan; Stephen M Davis Journal: N Engl J Med Date: 2018-04-26 Impact factor: 91.245
Authors: Thorsten Steiner; Rustam Al-Shahi Salman; Ronnie Beer; Hanne Christensen; Charlotte Cordonnier; Laszlo Csiba; Michael Forsting; Sagi Harnof; Catharina J M Klijn; Derk Krieger; A David Mendelow; Carlos Molina; Joan Montaner; Karsten Overgaard; Jesper Petersson; Risto O Roine; Erich Schmutzhard; Karsten Schwerdtfeger; Christian Stapf; Turgut Tatlisumak; Brenda M Thomas; Danilo Toni; Andreas Unterberg; Markus Wagner Journal: Int J Stroke Date: 2014-08-24 Impact factor: 5.266